Analysis of patients discharged from the general medicine department of a tertiary A-grade hospital in Jiangsu province from 2023 to 2024
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摘要:
目的 分析徐州市中心医院全科医学科出院患者诊疗情况, 总结疾病谱特点，为全科医学发展及政策制定提供依据。 方法 从徐州市中心医院电子病历数据库中提取2023年6月1日—2024年5月31日全科病房出院患者病历资料，包括人口学信息、诊断及住院相关指标。 结果 全科医学科1年内出院患者共725例次, 男性347例次（47.86%），女性378例次（52.14%），年龄为(57.66±14.83)岁，住院时间为7(6, 9)d，住院费用为6 502.46(5 511.46, 7 662.79)元。入院诊断为未分化疾病的患者医疗资源消耗量显著低于诊断明确的患者（P＜0.05）。出院主诊断排在前5位的分别为脑梗死及椎基底动脉综合征(230例，31.72%)、2型糖尿病及相关并发症（106例，14.62%)、胃食管反流及慢性胃炎(82例，11.31%)、呼吸道感染(45例，6.21%)、心身疾病（34例, 4.69%）。不同慢性病数量患者的住院时间、住院费用差异均有统计学意义，住院时间与住院费用随慢性病数目增多呈上升趋势（P＜0.001）。 结论 全科医学科的诊疗对象包括各个年龄段的患者，涉及多个系统的疾病谱。该领域不仅涵盖常见病和慢性病，还包括未分化疾病及心身疾病，且多病共存的患者比例较高，这些特点与全科医学的发展趋势密切相关。 Abstract:Objective To analyze the diagnosis and treatment profile of discharged patients from the Department of General Practice at Xuzhou Central Hospital, summarize the characteristics of the disease spectrum, and provide evidence for the development of general practice and health policy-making. Methods Medical records of patients discharged from the general medicine ward between June 1, 2023, and May 31, 2024, were extracted from the hospital's electronic database, including demographic information, diagnoses, and hospitalization-related indicators. Results A total of 725 patients were discharged from the Department of General Practice within one year, including 347 males (47.86%) and 378 females (52.14%). Age was (57.66±14.83) years; length of hospital stay was 7 (6, 9) d; and hospitalization cost was 6 502.46 (5 511.46, 7 662.79) CNY. Patients admitted with undifferentiated diseases showed significantly lower medical resource consumption compared to those with clear diagnoses upon admission (P < 0.05). The top five primary discharge diagnoses were: cerebral infarction and vertebrobasilar syndrome (230 cases, 31.72%), type 2 diabetes mellitus and related complications (106 cases, 14.62%), gastroesophageal reflux disease and chronic gastritis (82 cases, 11.31%), respiratory tract infections (45 cases, 6.21%), and psychosomatic diseases (34 cases, 4.69%). There were statistically significant differences in length of hospital stay and hospitalization costs among patients with different numbers of chronic diseases, and both indicators increased with the rising number of chronic diseases (P < 0.001). Conclusion The Department of General Practice treats patients across all age groups and covers a broad spectrum of diseases involving multiple systems. Its scope includes not only common and chronic diseases but also undifferentiated and psychosomatic diseases, with a high proportion of patients having multimorbidity. These characteristics are closely aligned with the evolving trends in general practice. -
表 1 725例次出院患者一般情况
Table 1. General information of 725 discharged patients
项目 例次 构成比(%) 性别 男性 347 47.86 女性 378 52.14 年龄 ＜10岁 2 0.28 10~18岁 11 1.52 19~29岁 7 0.97 30~39岁 63 8.69 40~49岁 113 15.59 50~59岁 198 27.31 60~69岁 172 23.72 70~79岁 109 15.03 80~89岁 46 6.34 ≥90岁 4 0.55 
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表 2 725例患者入院诊断的构成分析
Table 2. Analysis of admission diagnosis composition among 725 patients
入院诊断 例次 构成比(%) 未分化疾病 318 43.86 腹痛 81 11.17 头晕 58 8.00 胸闷 46 6.34 胸痛 24 3.31 其他 109 15.03 内分泌系统 103 14.21 糖尿病及相关并发症 89 12.28 甲亢 5 0.69 其他 9 1.24 神经系统 100 13.79 脑梗死 68 9.38 椎基底动脉综合征 17 2.34 其他 15 2.07 心血管系统 70 9.66 高血压 43 5.93 冠心病 15 2.07 其他 12 1.66 消化系统 48 6.62 胃食管反流 18 2.48 慢性胃炎 13 1.79 其他 17 2.34 呼吸系统 41 5.66 呼吸道感染 30 4.14 慢性阻塞性肺疾病 5 0.69 其他 6 0.83 其他疾病 45 6.21
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表 3 是否未分化疾病组间住院时间和住院费用比较[M(P25, P75)]
Table 3. Comparison of stay length and hospitalization costs between undifferentiated disease subgroups [M(P25, P75)]
是否未分化疾病 例次 住院时间(d) 住院费用(元) 否 407 7(6, 9) 6 655.93(5 536.78, 7 971.98) 是 318 7(6, 8) 6 435.31(5 454.28, 7 482.34) Z值 3.530 2.300 P值 ＜0.001 0.021
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表 4 未分化疾病前10位疾病构成比情况
Table 4. Composition ratio of the top 10 undifferentiated diseases
诊断 例次 构成比(%) 腹痛 81 11.17 头晕 58 8.00 胸闷 46 6.34 胸痛 24 3.31 发热 17 2.34 心悸 17 2.34 水肿 13 1.79 头痛 11 1.52 乏力 9 1.24 咳嗽 6 0.83
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表 5 725例患者出院主诊断的构成分析
Table 5. Composition analysis of primary discharge diagnoses among 725 patients
出院诊断 例次 构成比(%) 神经系统疾病 252 34.76 脑梗死 189 26.07 椎基底动脉综合征 41 5.66 血管性头痛 4 0.55 前庭性头晕 4 0.55 其他 14 1.93 内分泌系统 130 17.93 2型糖尿病及相关并发症 106 14.62 高脂血症 9 1.24 甲状腺功能亢进症 8 1.10 甲状腺功能减退症 2 0.28 其他 5 0.69 消化系统疾病 116 16.00 胃食管反流 46 6.34 慢性胃炎 36 4.97 胃肠息肉 11 1.52 其他 23 3.17 呼吸系统疾病 68 9.38 肺部感染 45 6.21 呼吸衰竭 9 1.24 慢性阻塞性肺疾病 4 0.55 支气管扩张 3 0.41 其他 7 0.97 循环系统疾病 65 8.97 高血压病 24 3.31 冠心病 13 1.79 期前收缩 9 1.24 冠状动脉粥样硬化 8 1.10 其他 11 1.52 心身疾病 34 4.69 焦虑状态 10 1.38 心脏神经官能症 13 1.79 胃肠功能紊乱 7 0.97 躯体症状障碍 2 0.28 惊恐障碍 1 0.14 情境性晕厥 1 0.14 脊柱关节病 28 3.86 恶性肿瘤 12 1.66 其他疾病 20 2.76
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表 6 不同共患慢性病个数患者住院时间、住院费用比较[M(P25, P75)]
Table 6. Comparison of stay length and hospitalization costs in patients with different numbers of comorbid chronic diseases [M(P25, P75)]
共患慢性病个数 例次 占比(%) 住院时间(d) 住院费用(元) 0个 264 36.41 6(5, 8) 5 895.82(4 956.02, 7 042.50) 1个 207 28.55 7(6, 9)a 6 516.73(5 577.74, 7 559.01)a 2个 149 20.55 7(6, 9)a 6 708.54(5 994.77, 7 714.10)a 3个 82 11.31 8(7, 10)abc 7 660.06(6 852.69, 9 288.05)abc 4个 20 2.76 9(7, 10)abc 7 862.92(5 957.66, 9 333.02)abc 5个 3 0.42 8(7, 9)abc 7 728.91(7 314.50, 8 518.22)abc H值 64.217 82.579 P值 ＜0.001 ＜0.001 注：与0个慢性病比较，aP＜0.05；与1个慢性病比较，bP＜0.05；与2个慢性病比较，cP＜0.05。
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